Dr. Marc Whitsett mD. Medical Director, Northland & The Ridge

Dr. Marc Whitsett MD. Medical Director, Northland & The Ridge

Dr. Whitsett is Board Certified in Internal Medicine and Addiction Medicine. He is the Medical Director for The Ridge and Northland Treatment Center. You can read his full bio here.

As an addictionologist I am frequently confronted with the question, “I must undergo surgery. What should I do about my Suboxone? What should I take for the pain after my surgery? Should I stop taking my Suboxone?” These are excellent questions and when asked, reflect responsibility in Recovery.

There is no consensus as to the “right” way to approach this issue. However, there are reasonable treatment modalities that address this difficult, if not infrequent, problem. No matter which method is chosen, it is always important for the patient to convey to all of their treating physicians the medicines they are prescribed and that they are actively taking. Ultimately your doctor will advise you on what to do, but having some knowledge will be helpful if you are ever faced with the situation.

Suboxone, which contains the blocker naloxone, has been approved for the treatment of opioid use disorder. The FDA has also approved buprenorphine, the active opioid in Suboxone, for the treatment of moderate to severe pain. Suboxone, while not approved for the treatment of pain, has analgesic properties that can help with pain after surgery.

One of the difficulties that may arise for a patient taking Suboxone who is undergoing surgery is the doctors may have difficulty obtaining effective anesthesia. In addition, pain after the surgery can be difficult to manage with regular prescription narcotics such as Percocet since Suboxone lowers the effectiveness of regular opioid narcotics.
Some of the accepted treatment recommendations include:

  1. Discontinuation of the Suboxone one day prior to the surgery, and then taking the Percocet [or similar] pain medicine after surgery; stay off the Suboxone while on the Percocet. Then re-introduce the Suboxone when the patient has been off the Percocet for at least 24 hours to avoid a phenomenon known as precipitated withdrawal [this occurs when Suboxone is given to a patient that is taking opioid analgesics, such as Percocet, and can be very uncomfortable]; or
  2. Continue Suboxone before and after the surgery. If additional pain medications are required after the surgery, the pain medications [e.g., Percocet] can be taken in addition to the Suboxone. The consensus seems to be that most patients can obtain pain relief with this method. With this method there is no discontinuation of the Suboxone and no risk of precipitated withdrawal; finally
  3. Another approach is to taper off the Suboxone 4-6 weeks prior to surgery, perform the surgery, take the pain medication(s) as prescribed, and then reintroduce Suboxone 24 hours after the last dose of pain medicine. The difficulty with this approach is most clients cannot stay off Suboxone or taper their Suboxone without a relapse.

My current clinical recommendation is to continue using Suboxone before and after the surgery without discontinuation at all. I encourage the treating physicians to manage the post-operative pain with alternative non-opioid medications including ketamine, a dissociative anesthetic that does not block the actions of Suboxone, and other non- narcotic medications such as Toradol (ketorolac). In addition, anesthesia doctors can provide “Pain Busters” or regional anesthesia for pain. For most patients, physicians can control their pain by taking Suboxone along with an anti-inflammatory medication such as ibuprofen or naproxen without having to take opioid narcotics such as Percocet.

No matter which approach is taken, the most important feature is to keep your eye on the Recovery Ball. Taking prescribed narcotic opioid pain medication is not a relapse if taken as prescribed without any “hidden agenda”; lying about taking opioid analgesics to your family or doctor may represent relapse. Being open and honest with your family, your doctors, and your sponsor are the keys to success.